Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
Aliment Pharmacol Ther. 2021 May;53(9):985-998. doi: 10.1111/apt.16305. Epub 2021 Mar 10.
Patients with cirrhosis are at risk of developing cirrhotic cardiomyopathy. This syndrome is unique to cirrhosis and is generally defined as subnormal cardiac function in the absence of prior heart disease. There is no systematic or comprehensive review of cirrhotic cardiomyopathy to date.
To comprehensively review the literature on the definition, pathogenic mechanisms, diagnostic criteria, prevalence, management and influence on liver transplantation including reversibility of cirrhotic cardiomyopathy.
Electronic searches of the EMBASE, MEDLINE, EBM Reviews-Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database of Systematic Reviews and Google Scholar databases were conducted. MeSH terms focused on cirrhosis, cardiomyopathy, medication classes and epidemiology. Literature up to August 2020 was reviewed.
New diagnostic criteria for the definition of cirrhotic cardiomyopathy have recently been published, consisting of systolic and diastolic dysfunction parameters as assessed by echocardiographic methods. The roles of electrocardiographic disturbances and biomarkers in the definition criteria remain unclear. Pathogenic mechanisms underlying cirrhotic cardiomyopathy are likely related to the inflammatory phenotype of cirrhosis. Prevalence rates of 26%-81% in cirrhotic patients are reported. Several medical therapies have been proposed, but none with clear evidence of efficacy. The presence of cirrhotic cardiomyopathy complicates the liver transplantation process with a higher risk of adverse cardiovascular events post-transplant. Complete reversibility of the syndrome after transplantation remains controversial but most studies suggest that it does not occur at least within the first post-operative year.
Cirrhotic cardiomyopathy is a clinically relevant syndrome that affects morbidity and mortality in patients with cirrhosis.
肝硬化患者存在发生肝硬化心肌病的风险。该综合征是肝硬化所特有的，通常定义为在没有先前心脏病的情况下存在心脏功能异常。迄今为止，尚无针对肝硬化心肌病的系统或全面综述。
全面回顾有关肝硬化心肌病的定义、发病机制、诊断标准、患病率、治疗以及对肝移植的影响，包括肝硬化心肌病的可逆性。
对 EMBASE、MEDLINE、EBM Reviews-Cochrane 中心对照试验注册库、EBM Reviews-Cochrane 系统评价数据库和 Google Scholar 数据库进行电子检索。主要使用了与肝硬化、心肌病、药物类别和流行病学相关的 MeSH 主题词。综述的文献截止日期为 2020 年 8 月。
最近发布了肝硬化心肌病定义的新诊断标准，包括通过超声心动图方法评估的收缩和舒张功能障碍参数。心电图异常和生物标志物在定义标准中的作用尚不清楚。肝硬化心肌病的发病机制可能与肝硬化的炎症表型有关。报道的肝硬化患者的患病率为 26%-81%。已经提出了几种药物治疗方法，但没有一种方法具有明确的疗效证据。肝硬化心肌病的存在使肝移植过程复杂化，增加了移植后发生不良心血管事件的风险。该综合征在移植后完全可逆性仍存在争议，但大多数研究表明，它至少在术后第一年不会发生。
肝硬化心肌病是一种与肝硬化患者发病率和死亡率相关的临床相关综合征。
